Spinal Anestezi Altında TUR-P Sendromu Gelişen Olguda Anestezi Yönetimi
Özet
Benign prostat hiperplazili (BPH), mesane çıkış obstrüksiyonu bulunan hastalarda transüretral prostat rezeksiyonu (TUR-P) altın standart tedavi yöntemidir (1). Rezeksiyon sırasında yüksek hacimde kullanılan irrigasyon sıvısının sistemik dolaşıma katılması %1.1 oranında TUR-P sendromuna yol açabilmektedir (2).
TUR-P sendromu, plazma elektrolit konsantrasyonlarında ani değişimlere neden olan iatrojenik bir su intoksikasyonudur. İntravasküler alandaki hacim ve elektrolit konsantrasyonlarının ani değişimi birçok semptoma yol açmaktadır. Baş ağrısı, konfüzyon, huzursuzluk, siyanoz, nöbet aktiviteleri, dispne, aritmi, hipotansiyon klinikte görülebilen semptomlardandır (3). TUR-P sendromu, en sık transüretral prostat rezeksiyonu sonrası görülmektedir, bunun yanı sıra sistoskopi, perkütan nefrolitotomi gibi cerrahi prosedürlerde de rastlanabilmektedir.
Olgumuzda BPH nedeniyle spinal anestezi altında gerçekleştirilen TUR-P esnasında TUR-P sendromu gelişen olgumuzun bulguları eşliğinde TUR-P sendromunda erken tanının önemini, semptomları, takip ve tedavi ilkelerini vurgulamayı amaçladık.
Transurethral resection of the prostate (TUR-P) is the gold standard treatment for patients with benign prostatic hyperplasia (BPH) and bladder outlet obstruction (1). During the resection, the high volume of irrigation fluid used can enter the systemic circulation, leading to TUR-P syndrome in approximately 1.1% of cases (2).
TUR-P syndrome is an iatrogenic water intoxication that results in sudden changes in plasma electrolyte concentrations. These abrupt changes in intravascular volume and electrolyte levels can cause a range of symptoms, including headache, confusion, restlessness, cyanosis, seizure activity, dyspnea, arrhythmias, and hypotension (3). TUR-P syndrome most commonly occurs following transurethral resection of the prostate but can also be seen in other surgical procedures such as cystoscopy and percutaneous nephrolithotomy.
In this case, we aim to highlight the importance of early diagnosis of TUR-P syndrome, its clinical manifestations, and the principles of monitoring and treatment, based on the findings from our patient who developed TUR-P syndrome during transurethral prostatectomy performed under spinal anesthesia for BPH.
Referanslar
Amu OC, Affusim EA, Nnadozie UU, et al. Outcome of Transurethral Resection of the Prostate (TURP) using 5% Dextrose Water as Irrigant. Nigerian Journal of Clinical Practice. 2023;26(10): 1568–1574. https://doi.org/10.4103/njcp.njcp_278_23.
Rassweiler J, Teber D, Kuntz R, et al. Complications of Transurethral Resection of the Prostate (TURP)—Incidence, Management, and Prevention. European Urology. 2006;50(5): 969–980. https://doi.org/10.1016/J.EURURO.2005.12.042.
Reich O, Gratzke C, Bachmann A, et al. Morbidity, Mortality and Early Outcome of Transurethral Resection of the Prostate: A Prospective Multicenter Evaluation of 10,654 Patients. The Journal of Urology. 2008;180(1): 246–249. https://doi.org/10.1016/J.JURO.2008.03.058.
Agrawal MS, Mishra DK. Transurethral Resection of Prostate. Journal of Endourology. 2022;36. https://doi.org/10.1089/end.2022.0305.
Dağli R, Dadali M, Üniversitesi AE, et al. Üreter ve mesane taşlarının endoskopik cerrahi ile tedavisinde ürologların anestezi yöntemi tercihleri. Ankara Eğt. Arş. Hast. Derg. 2017.
Hawary A, Mukhtar K, Sinclair A, et al. Transurethral resection of the prostate syndrome: Almost gone but not forgotten. Journal of Endourology. 2009. https://doi.org/10.1089/end.2009.0129.
Zepnick H, Steinbach F, Schuster F. Value of transurethral resection of the prostate (TURP) for treatment of symptomatic benign prostatic obstruction (BPO): An analysis of efficiency and complications in 1015 cases. Aktuelle Urologie. 2008;39(5). https://doi.org/10.1055/s-2008-1038222.
Gupta K, Rastogi B, Jain M, et al. Electrolyte changes: An indirect method to assess irrigation fluid absorption complications during transurethral resection of prostate: A prospective study. Saudi Journal of Anaesthesia. 2010;4(3). https://doi.org/10.4103/1658-354x.71505.
Singh S, Kumar N, Paul D, et al. A case of operative hysteroscopy intravascular absorption syndrome: Gynaecological TURP syndrome. Indian Journal of Anaesthesia. 2021. https://doi.org/10.4103/ija.IJA_867_20.
Tokas T, Ortner G, Herrmann TRW, et al. Relevance of intravesical pressures during transurethral procedures. World Journal of Urology. 2020. https://doi.org/10.1007/s00345-020-03401-x.
Al-Bakri A, Al-Jaser A, Al-Gamdi K, et al. Safety of transurethral resection of large prostate. Urology Annals. 2023;15(2). https://doi.org/10.4103/ua.ua_192_21.
Hahn RG, Nilsson A, Farahmand BY, et al. Operative factors and the long-term incidence of acute myocardial infarction after transurethral resection of the prostate. Epidemiology. 1996;7(1). https://doi.org/10.1097/00001648-199601000-00016.
Kang E, Lee B cheol, Lee H, et al. Transurethral resection of the prostate syndrome with severe lactic acidosis due to the use of sorbitol-mannitol irrigating fluid: A case report. Urology Case Reports. 2023;46. https://doi.org/10.1016/j.eucr.2022.102292.
Iihoshi M, Sakuragi T, Higa K, et al. Severe hyponatremia during transurethral resection of prostate. Japanese Journal of Anesthesiology. 2005;54(4).
Yildiz G, Kayataş M, Candan F. Hiponatremi; güncel tani ve tedavisi. Turkish Nephrology, Dialysis and Transplantation Journal. 2011. p. 115–131. https://doi.org/10.5262/tndt.2011.1002.02.
Sterns RH, Hix JK, Silver SM. Management of hyponatremia in the ICU. Chest. 2013. https://doi.org/10.1378/chest.12-2600.
Hoorn EJ, Zietse R. Diagnosis and treatment of hyponatremia: Compilation of the guidelines. Journal of the American Society of Nephrology. 2017. https://doi.org/10.1681/ASN.2016101139.
Stafford-Smith M, Shaw A, Sandler A, et al. The renal system and anesthesia for urologic surgery. In: Clinical Anesthesia: Seventh Edition. 2013.
HERGÜNSEL O, KENDİR V, Eren G, et al. Spinal anestezi altında TUR-P sendromu gelişen bir olgu: Olgu sunumu. Bakırköy Tıp Dergisi. 2010;6(4): 174–177. http://search/yayin/detay/112557
Kara C, Resorlu B, Cicekbilek I, et al. Analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs after transurethral resection of prostate. International Braz J Urol. 2010;36(1): 49–54. https://doi.org/10.1590/S1677-55382010000100008.
Referanslar
Amu OC, Affusim EA, Nnadozie UU, et al. Outcome of Transurethral Resection of the Prostate (TURP) using 5% Dextrose Water as Irrigant. Nigerian Journal of Clinical Practice. 2023;26(10): 1568–1574. https://doi.org/10.4103/njcp.njcp_278_23.
Rassweiler J, Teber D, Kuntz R, et al. Complications of Transurethral Resection of the Prostate (TURP)—Incidence, Management, and Prevention. European Urology. 2006;50(5): 969–980. https://doi.org/10.1016/J.EURURO.2005.12.042.
Reich O, Gratzke C, Bachmann A, et al. Morbidity, Mortality and Early Outcome of Transurethral Resection of the Prostate: A Prospective Multicenter Evaluation of 10,654 Patients. The Journal of Urology. 2008;180(1): 246–249. https://doi.org/10.1016/J.JURO.2008.03.058.
Agrawal MS, Mishra DK. Transurethral Resection of Prostate. Journal of Endourology. 2022;36. https://doi.org/10.1089/end.2022.0305.
Dağli R, Dadali M, Üniversitesi AE, et al. Üreter ve mesane taşlarının endoskopik cerrahi ile tedavisinde ürologların anestezi yöntemi tercihleri. Ankara Eğt. Arş. Hast. Derg. 2017.
Hawary A, Mukhtar K, Sinclair A, et al. Transurethral resection of the prostate syndrome: Almost gone but not forgotten. Journal of Endourology. 2009. https://doi.org/10.1089/end.2009.0129.
Zepnick H, Steinbach F, Schuster F. Value of transurethral resection of the prostate (TURP) for treatment of symptomatic benign prostatic obstruction (BPO): An analysis of efficiency and complications in 1015 cases. Aktuelle Urologie. 2008;39(5). https://doi.org/10.1055/s-2008-1038222.
Gupta K, Rastogi B, Jain M, et al. Electrolyte changes: An indirect method to assess irrigation fluid absorption complications during transurethral resection of prostate: A prospective study. Saudi Journal of Anaesthesia. 2010;4(3). https://doi.org/10.4103/1658-354x.71505.
Singh S, Kumar N, Paul D, et al. A case of operative hysteroscopy intravascular absorption syndrome: Gynaecological TURP syndrome. Indian Journal of Anaesthesia. 2021. https://doi.org/10.4103/ija.IJA_867_20.
Tokas T, Ortner G, Herrmann TRW, et al. Relevance of intravesical pressures during transurethral procedures. World Journal of Urology. 2020. https://doi.org/10.1007/s00345-020-03401-x.
Al-Bakri A, Al-Jaser A, Al-Gamdi K, et al. Safety of transurethral resection of large prostate. Urology Annals. 2023;15(2). https://doi.org/10.4103/ua.ua_192_21.
Hahn RG, Nilsson A, Farahmand BY, et al. Operative factors and the long-term incidence of acute myocardial infarction after transurethral resection of the prostate. Epidemiology. 1996;7(1). https://doi.org/10.1097/00001648-199601000-00016.
Kang E, Lee B cheol, Lee H, et al. Transurethral resection of the prostate syndrome with severe lactic acidosis due to the use of sorbitol-mannitol irrigating fluid: A case report. Urology Case Reports. 2023;46. https://doi.org/10.1016/j.eucr.2022.102292.
Iihoshi M, Sakuragi T, Higa K, et al. Severe hyponatremia during transurethral resection of prostate. Japanese Journal of Anesthesiology. 2005;54(4).
Yildiz G, Kayataş M, Candan F. Hiponatremi; güncel tani ve tedavisi. Turkish Nephrology, Dialysis and Transplantation Journal. 2011. p. 115–131. https://doi.org/10.5262/tndt.2011.1002.02.
Sterns RH, Hix JK, Silver SM. Management of hyponatremia in the ICU. Chest. 2013. https://doi.org/10.1378/chest.12-2600.
Hoorn EJ, Zietse R. Diagnosis and treatment of hyponatremia: Compilation of the guidelines. Journal of the American Society of Nephrology. 2017. https://doi.org/10.1681/ASN.2016101139.
Stafford-Smith M, Shaw A, Sandler A, et al. The renal system and anesthesia for urologic surgery. In: Clinical Anesthesia: Seventh Edition. 2013.
HERGÜNSEL O, KENDİR V, Eren G, et al. Spinal anestezi altında TUR-P sendromu gelişen bir olgu: Olgu sunumu. Bakırköy Tıp Dergisi. 2010;6(4): 174–177. http://search/yayin/detay/112557
Kara C, Resorlu B, Cicekbilek I, et al. Analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs after transurethral resection of prostate. International Braz J Urol. 2010;36(1): 49–54. https://doi.org/10.1590/S1677-55382010000100008.
